Individual
MR. JARROD WAYNE STATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RSW
Contact information
Practice address
1202 KIRKMAN ST STE C, LAKE CHARLES, LA 70601-5391
(337) 990-5305
Mailing address
1202 KIRKMAN ST STE C, LAKE CHARLES, LA 70601-5391
(337) 990-5305
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
17045
LA
Other
Enumeration date
01/20/2022
Last updated
02/02/2022
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